This study aims to evaluate the effectiveness of a VR intervention on teaching handwashing skills which are promoted by the Centre for Health Protection, Department of Health, HKSAR. A 7-step handwashing approach will be taught through a customized VR game in secondary schools in Hong Kong. Participant's handwashing skills and prolonged effects on handwashing habits and hygiene level will be assessed. The main questions it aims to answer are: * Does an intervention of our VR handwashing game enhance handwashing skills amongst junior secondary students? * What are the factors hinder or enhance students' learning of handwashing skills in the intervention? Participating students will be assigned into 3 groups. Each group will receive two sessions of educational training with different kinds of intervention throughout one school year (9 months). The first intervention group will participate in two VR-game sessions on handwashing skill; the second intervention group will participate in one VR-game session and one video session about handwashing; the baseline group will participate in two sessions of other VR activities unrelated to hand hygiene and view a handwashing skill poster. The research will compare the handwashing performance between the three groups. Participants will: * participate into a VR handwashing game intervention, or a video-based intervention, or placebo VR activities as stated hereinafter; * perform handwashing in the VR game, and their hand-motion data will be captured; * participate a UV lighting test after handwashing away fluorescent lotion; and, * fill up questionnaires
Schools are often the site of infection outbreaks, including COVID-19, influenza and other infectious diseases. COVID-19 pandemic has accelerated the need to enhance hygiene levels at primary and secondary schools and, specifically, nurturing and enforcing students' regular handwashing practices is one of the key components of a preventive strategy to reduce the transmission of infectious illnesses. Meanwhile, Virtual Reality (VR) intervention has been shown to be an efficacious tool for behavioural change. It manipulates an array of behavioural and environmental variables to construct an immersive virtual environment for changing certain human behaviours. VR handwashing education system may be more helpful than conventional verbal explanation in encouraging school children to wash their hands thoroughly, especially overcoming difficult to wash areas including wrists. Nevertheless, a school-based VR intervention on handwashing education is lacked in Hong Kong. Objective: This study aims to evaluate the effectiveness of a VR intervention on teaching handwashing skills which are promoted by the Centre for Health Protection, Department of Health, HKSAR. A 7-step handwashing approach will be taught through a customized VR game in secondary schools in Hong Kong. Participant's handwashing skills and prolonged effects on handwashing habits and hygiene level will be assessed. Methods: A 3-arm randomized controlled trial will be adopted. About 500 students will be assigned into 3 groups which will be randomly assigned on class-basis. Each group will receive two sessions of educational training with different kinds of intervention throughout one school year (9 months). The first intervention group will participate in two VR-game sessions on handwashing skill; the second intervention group will participate in one VR-game session and one video session about handwashing; the baseline group will participate in two sessions of other VR activities unrelated to hand hygiene and view a handwashing skill poster. Comparison of pre- and post-intervention hand-images of participants will serve as primary measurement. Ultraviolet-sensitive fluorescent lotion will be applied to the participants' hands and digital photos will be taken under UV lighting environment. Image comparisons will adopt quantitative method of calculating the percentage of fluorescent pixels over total hand areas. Post-intervention hand-images will be collected 3 months after the second intervention in order to capture any prolonged effect on handwashing over the whole intervention period. The secondary measures will be deployed through pre-invention, immediate post-intervention and follow-up (3 months after intervention) surveys. The survey will comprise scales measuring self-efficacy, knowledge on hand hygiene, handwashing habits and intentions, attitudes, subjective norms, and perceived behavioral control, VR embodiment and VR experience. Results: The project has already commenced in March 2026. The data collection period of the randomized controlled trial will be started from Sep 2026 and will end in May 2027. Data will be analyzed during June and August 2027, and the results are expected to be released in September 2027. Conclusion: This study contributes to existing knowledge about infection prevention strategy through VR game as well as the hand hygiene of the student population in Hong Kong and elsewhere. The study fills a number of research gaps in the field by (1.) developing evidence-based and executable VR hand hygiene programmes in school settings; (2.) addressing the ill-solved sustainability issue of hand hygiene intervention effects; (3.) identifying factors underlying the pathway of behavioural changes on hand hygiene and issues related to barriers to change, and (4.) identifying handwashing patterns through hand motion data shaping the hand hygiene level. The experiences and results from this VR game project can be also transferable to develop other programme regarding public health by adopting VR devices.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
500
The intervention will be a VR game taught about the '7-Steps approach' of hand-washing promoted by Centre for Health Protection, HKSAR. The game is comprised of two parts: Training Mode and Challenge Mode. In Training Mode, students will be guided with text and voice feedback. A pair of 'ghost hands' will demonstrate what to do. Students follow the movements of the 'ghost hands' to complete the handwashing tasks. In the Challenge Mode, students are requested to perform all the steps at once by their own memory, hints will be given only when they encounter setback in an assigned duration. Trained facilitators will teach participants how to use the VR devices and provide briefing sessions on how to play the game. For the Intervention Group 1, they will play the game in two separate sessions (about 4 months between the two sessions).
For Intervention Group 2, participants will attain one VR game session and 1 video-instructed session.
School of Future Media, The University of Hong Kong
Hong Kong, Hong Kong
RECRUITINGHand-imaging Data
Ultraviolet-sensitive fluorescent lotion (e.g., Glo Germ™) will be applied on participants' hands thoroughly to simulate full contamination (e.g., germs and pathogens) on hands. Then participants wash their hands. The areas where lotion has been washed out are considered as 'decontaminated'. The participants will put their washed hands in a black box with an Ultraviolet-A (365nm) lighting system. Both palms and dorsa of left and right hands will be photographed.
Time frame: Hand-imaging data will only be collected before the 1st intervention and at the end of the data collection period (about 9 months after the 1st intervention).
Knowledge on Hand Hygiene and Handwashing
As this study is focused on handwashing skills and steps, questionnaires on this field are usually customized for the context of the research (i.e., steps and skills can be differed between studies). As our interventions mainly teach about the 7-handwashing steps suggested by the Centre for Health Protection, Department of Health, HKSAR, five questions will be developed to assess participants' knowledge of the handwashing procedures.
Time frame: This measurement will be collected through questionnaire pre-intervention, immediately after 1st intervention, after 2nd intervention (5 months after 1st intervention) and in the follow-up survey (9 months after 1st intervention).
Handwashing Habit
Two components on handwashing habit will be measured frequency of handwashing. Five items on how often the participants cleaned their hands on five different scenarios (before meal, after using washroom, after taking public transportation, after arriving at the school and after going back home) will be asked to measure the frequency of handwashing (5-point scale from 'never' to 'always'.
Time frame: This measurement will be collected through questionnaire pre-intervention, immediately after 1st intervention, after 2nd intervention (5 months after 1st intervention) and in the follow-up survey (9 months after 1st intervention).
Attitude and Intention
The attitude on automaticity of handwashing habit will be measured by the Self-Report Behaviour Automaticity Index (SRBAI), which has already been modified and validated into four items regarding handwashing in another study. The sample item is 'Hand washing is something I start doing before I realise I'm doing it'. The four items are measured on a 7-point Likert scale, ranging from 1 ("does not apply to me at all") to 7 ("completely applies to me"). Behavioural intention will be measured by a single item : "In my daily routine, I want to perform hand hygiene as correctly as possible" on a 7-point Likert scale.
Time frame: This measurement will be collected through questionnaire pre-intervention, immediately after 1st intervention, after 2nd intervention (5 months after 1st intervention) and in the follow-up survey (9 months after 1st intervention).
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